Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

D&C DIAG OR THERAP NOT OB

Facility

$16,333.80

Service Code	HCPCS 58120
Hospital Charge Code	16000760
Hospital Revenue Code	360
Min. Negotiated Rate	$2,450.07
Max. Negotiated Rate	$2,450.07
Rate for Payer: Qualcare PPO/HMO/WC	$2,450.07

DCELL155

Facility

$15,525.00

Hospital Charge Code	270657244
Hospital Revenue Code	278
Min. Negotiated Rate	$2,328.75
Max. Negotiated Rate	$3,757.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,757.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,415.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,328.75

DCELL155

Facility

$15,525.00

Hospital Charge Code	270657244
Hospital Revenue Code	278
Min. Negotiated Rate	$374.15
Max. Negotiated Rate	$7,762.50
Rate for Payer: Aetna Commercial	$5,899.50
Rate for Payer: Aetna Medicare Advantage	$4,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,958.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,958.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,958.88
Rate for Payer: Cigna Commercial	$7,762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,757.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,415.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,328.75
Rate for Payer: UnitedHealthcare Community & State	$374.15
Rate for Payer: Wellpoint Medicaid Managed Care	$411.41

DCP DES GAMMA CARBXY PROTHRMBN

Facility

$1,495.05

Service Code	HCPCS 83951
Hospital Charge Code	39990238
Hospital Revenue Code	301
Min. Negotiated Rate	$39.62
Max. Negotiated Rate	$747.52
Rate for Payer: Aetna Commercial	$175.20
Rate for Payer: Aetna Medicare Advantage	$208.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$64.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.50
Rate for Payer: Cigna Commercial	$747.52
Rate for Payer: Cigna Medicare Advantage	$64.41
Rate for Payer: Clover Medicare Advantage	$61.19
Rate for Payer: EmblemHealth Commercial	$193.23
Rate for Payer: Humana Medicare Advantage	$66.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$64.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$448.51
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$224.26
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$51.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.41
Rate for Payer: Wellcare Medicare Advantage	$64.41
Rate for Payer: Wellpoint Medicaid Managed Care	$39.62

DCP DES GAMMA CARBXY PROTHRMBN

Facility

$1,495.05

Service Code	HCPCS 83951
Hospital Charge Code	39990238
Hospital Revenue Code	301
Min. Negotiated Rate	$224.26
Max. Negotiated Rate	$224.26
Rate for Payer: Qualcare PPO/HMO/WC	$224.26

DDAVP, 0.1MG,TAB

Facility

$54.81

Service Code	NDC 55566220000
Hospital Charge Code	60635434
Hospital Revenue Code	250
Min. Negotiated Rate	$8.22
Max. Negotiated Rate	$8.22
Rate for Payer: Qualcare PPO/HMO/WC	$8.22

DDAVP, 0.1MG,TAB

Facility

$54.81

Service Code	NDC 55566220000
Hospital Charge Code	60635434
Hospital Revenue Code	250
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$27.41
Rate for Payer: Aetna Commercial	$20.83
Rate for Payer: Aetna Medicare Advantage	$16.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.98
Rate for Payer: Cigna Commercial	$27.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.44
Rate for Payer: Oxford Commercial	$10.96
Rate for Payer: Qualcare PPO/HMO/WC	$8.22
Rate for Payer: UnitedHealthcare Commercial	$10.96
Rate for Payer: UnitedHealthcare Community & State	$1.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.45

DDAVP NASAL/0.1MG/1ML

Facility

$235.00

Hospital Charge Code	60632779
Hospital Revenue Code	250
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$117.50
Rate for Payer: Aetna Commercial	$89.30
Rate for Payer: Aetna Medicare Advantage	$70.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.92
Rate for Payer: Cigna Commercial	$117.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.50
Rate for Payer: Oxford Commercial	$47.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.25
Rate for Payer: UnitedHealthcare Commercial	$47.00
Rate for Payer: UnitedHealthcare Community & State	$5.66
Rate for Payer: Wellpoint Medicaid Managed Care	$6.23

DDAVP NASAL/0.1MG/1ML

Facility

$235.00

Hospital Charge Code	60632779
Hospital Revenue Code	250
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$35.25
Rate for Payer: Qualcare PPO/HMO/WC	$35.25

D-DIMER (LATEX)****

Facility

$730.00

Service Code	HCPCS 85378
Hospital Charge Code	3009180
Hospital Revenue Code	305
Min. Negotiated Rate	$109.50
Max. Negotiated Rate	$109.50
Rate for Payer: Qualcare PPO/HMO/WC	$109.50

D-DIMER (LATEX)****

Facility

$730.00

Service Code	HCPCS 85378
Hospital Charge Code	3009180
Hospital Revenue Code	305
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$365.00
Rate for Payer: Aetna Commercial	$26.44
Rate for Payer: Aetna Medicare Advantage	$31.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.09
Rate for Payer: Cigna Commercial	$365.00
Rate for Payer: Cigna Medicare Advantage	$9.72
Rate for Payer: Clover Medicare Advantage	$9.23
Rate for Payer: EmblemHealth Commercial	$29.16
Rate for Payer: Humana Medicare Advantage	$10.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$109.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.72
Rate for Payer: Wellcare Medicare Advantage	$9.72
Rate for Payer: Wellpoint Medicaid Managed Care	$19.34

D - DIMER,QUANT

Facility

$131.00

Service Code	HCPCS 85379
Hospital Charge Code	38478027
Hospital Revenue Code	305
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

D - DIMER,QUANT

Facility

$131.00

Service Code	HCPCS 85379
Hospital Charge Code	38478027
Hospital Revenue Code	305
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$27.69
Rate for Payer: Aetna Medicare Advantage	$32.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.75
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: Cigna Medicare Advantage	$10.18
Rate for Payer: Clover Medicare Advantage	$9.67
Rate for Payer: EmblemHealth Commercial	$30.54
Rate for Payer: Humana Medicare Advantage	$10.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.18
Rate for Payer: Wellcare Medicare Advantage	$10.18
Rate for Payer: Wellpoint Medicaid Managed Care	$3.47

D-DIMER QUANTITATIVE

Facility

$44.00

Service Code	HCPCS 85380
Hospital Charge Code	3009185
Hospital Revenue Code	305
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$27.69
Rate for Payer: Aetna Medicare Advantage	$32.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.75
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: Cigna Medicare Advantage	$10.18
Rate for Payer: Clover Medicare Advantage	$9.67
Rate for Payer: EmblemHealth Commercial	$30.54
Rate for Payer: Humana Medicare Advantage	$10.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.18
Rate for Payer: Wellcare Medicare Advantage	$10.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

D-DIMER QUANTITATIVE

Facility

$44.00

Service Code	HCPCS 85380
Hospital Charge Code	3009185
Hospital Revenue Code	305
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

DEBAKEY HEPARIN CANN.

Facility

$207.50

Hospital Charge Code	270667114
Hospital Revenue Code	272
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$103.75
Rate for Payer: Aetna Commercial	$78.85
Rate for Payer: Aetna Medicare Advantage	$62.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.91
Rate for Payer: Cigna Commercial	$103.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.25
Rate for Payer: Oxford Commercial	$41.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.12
Rate for Payer: UnitedHealthcare Commercial	$41.50
Rate for Payer: UnitedHealthcare Community & State	$5.00
Rate for Payer: Wellpoint Medicaid Managed Care	$5.50

DEBAKEY HEPARIN CANN.

Facility

$207.50

Hospital Charge Code	270667114
Hospital Revenue Code	272
Min. Negotiated Rate	$31.12
Max. Negotiated Rate	$31.12
Rate for Payer: Qualcare PPO/HMO/WC	$31.12

DEB BONE 20 SQ CM/<

Facility

$6,929.76

Service Code	HCPCS 11044
Hospital Charge Code	16000223
Hospital Revenue Code	360
Min. Negotiated Rate	$1,039.46
Max. Negotiated Rate	$1,039.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.46

DEB BONE 20 SQ CM/<

Facility

$6,929.76

Service Code	HCPCS 11044
Hospital Charge Code	16000223
Hospital Revenue Code	360
Min. Negotiated Rate	$167.01
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,078.93
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.46
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$167.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$394.27
Rate for Payer: Wellpoint Medicaid Managed Care	$386.54

DEB MUSC/FASCIA 20 SQ CM/<

Facility

$2,989.82

Service Code	HCPCS 11043
Hospital Charge Code	16000205
Hospital Revenue Code	360
Min. Negotiated Rate	$448.47
Max. Negotiated Rate	$448.47
Rate for Payer: Qualcare PPO/HMO/WC	$448.47

DEB MUSC/FASCIA 20 SQ CM/<

Facility

$2,989.82

Service Code	HCPCS 11043
Hospital Charge Code	16000205
Hospital Revenue Code	360
Min. Negotiated Rate	$72.05
Max. Negotiated Rate	$3,169.46
Rate for Payer: Aetna Commercial	$2,388.27
Rate for Payer: Aetna Medicare Advantage	$2,844.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,169.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,169.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$878.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,169.46
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: Cigna Medicare Advantage	$878.04
Rate for Payer: Clover Medicare Advantage	$834.14
Rate for Payer: EmblemHealth Commercial	$2,634.12
Rate for Payer: Humana Medicare Advantage	$904.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$878.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$896.95
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$448.47
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$72.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$878.04
Rate for Payer: Wellcare Medicare Advantage	$878.04
Rate for Payer: Wellpoint Medicaid Managed Care	$79.23

DEB MUSC/FASCIA ADD-ON =<20 SQ

Facility

$5,183.00

Service Code	HCPCS 11046
Hospital Charge Code	16000464
Hospital Revenue Code	360
Min. Negotiated Rate	$777.45
Max. Negotiated Rate	$777.45
Rate for Payer: Qualcare PPO/HMO/WC	$777.45

DEB MUSC/FASCIA ADD-ON =<20 SQ

Facility

$5,183.00

Service Code	HCPCS 11046
Hospital Charge Code	16000464
Hospital Revenue Code	360
Min. Negotiated Rate	$124.91
Max. Negotiated Rate	$2,591.50
Rate for Payer: Aetna Commercial	$1,969.54
Rate for Payer: Aetna Medicare Advantage	$1,554.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,321.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,321.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,321.66
Rate for Payer: Cigna Commercial	$2,591.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.90
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$777.45
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$124.91
Rate for Payer: Wellpoint Medicaid Managed Care	$137.35

DEBRD SQ. MUSCLE & BONE

Facility

$7,943.37

Service Code	HCPCS 11044
Hospital Charge Code	5780001
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$394.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,383.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,191.51
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$394.27
Rate for Payer: Wellpoint Medicaid Managed Care	$210.50

DEBRD SQ. MUSCLE & BONE

Facility

$7,943.37

Service Code	HCPCS 11044
Hospital Charge Code	5780001
Hospital Revenue Code	450
Min. Negotiated Rate	$1,191.51
Max. Negotiated Rate	$1,191.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,191.51

Know your out-of-pocket cost for care.

All Charges